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Perspectives on Psychotherapy

By:Hugh Rosen

The origins of professional psychotherapy are to be found in psychoanalysis, developed by Sigmund Freud. In earlier days it was frequently referred to as “the talking cure.” Although the key concept of the unconscious in Freud’s system did not originate with him, it was he who formalized it into a complex theory and basis for treatment.

Psychoanalysis was known to be a lengthy process, conducted three to five days a week over a period of many years. Ironically, some of Freud’s best-known cases were brief. In contemporary times, psychoanalysis has not only been further developed and refined, but has splintered into many camps, each of which still call themselves “psychoanalysis” or “psychodynamic” psychotherapy, an adaptation of psychoanalysis. Today, the various camps sometimes barely resemble one another and often deny that the other is really “psychoanalysis.”

Furthermore, there has occurred over the decades a proliferation of psychotherapies so that in contemporary times, if categorized finely enough, one could point to hundreds of therapeutic models of practice. In an attempt to avoid being overwhelmed by this jungle of paradigmatic approaches, modern textbooks on “comparative psychotherapies,” usually cover a range of from 8 to 12 of the most prominent ones.

Foremost amongst these are the psychodynamic therapies, humanistic therapies (client-centered, gestalt, and existential), solution-oriented therapies, Ericksonian psychotherapy, constructivist therapy, behavior therapy, and cognitive therapy. The last two of these have been combined into a hybrid of cognitive-behavioral psychotherapy.

The cognitive-behavior approaches are the most committed to scientific research projects, in which its efficacy is amply demonstrated to cut across a wide range of diagnostic categories. The profession of psychology has played the largest role in developing and researching this approach. Psychoanalysis has been most notably taught to and practiced by psychiatrists, although that profession has recently been moving in the direction of emphasizing biological approaches, relying heavily upon psychotropic drugs (medication).

Psychiatrists are medical doctors and, hence, have the authority to dispense medications. The field of psychology has been for years in the process of attempting to obtain legal permission to also prescribe medication, but has thus far has not been successful, largely because of opposition from the medical profession.

Medication for psychological disorders is indisputably effective in treating many diagnostic categories, such as depression, anxiety, obsessive-compulsiveness, and schizophrenia. Nevertheless there exists a philosophical debate in the mental health professions over whether drug treatment alone truly deals with the complexity of life’s problems, meaning, and existence. Of course, medication and talk therapy are not mutually exclusive, and are often used in combination.

I have mentioned only psychologists and psychiatrists, but other professionals such as clinical social workers and clinical nurses also constitute professions that provide practicing psychotherapists.

It is not uncommon for members of all these groups and others to seek out further training at institutes or centers that focus on one particular method of doing therapy and this training may last from one to three or four years. In addition there are many weekend or weeklong conferences and workshops throughout each year, which are held around the country and abroad, which further enrich the clinicians theory and skills.

Professional organizations require that their membership take a designated number of continuing education courses yearly, so as not to fall behind advances in their field

One of the potential pitfalls of intensive study and training in a single method is that the individual becomes so wedded to that one approach to the point of embracing it as a pseudo-religion. Therapeutic rigor mortis sets in, leaving no room for flexibility. Some have dealt with this by using only scientifically validated techniques and tactics, while others have moved toward eclecticism, being willing to step outside of one’s favored model of practice when results are not in evidence and trying other approaches.

More complex efforts attempting to integrate multiple therapeutic models into a transcendental paradigm have also been made. However, this is a more ambitious task, as the tenets of some of the models are practically and philosophically incompatible. All therapies require flexibility and creativity when implemented at their best; and I would go so far as to say that sometimes, in the face of an intractable client or patient, some risk-taking in the direction of even further innovation in tactics is called for. Such patients should be seen as challenges and not obstacles.

The one thing that all therapies have in common is a human relationship. Paradoxically, the research reveals that the client or patient places primary emphasis upon the personality of her therapist and their relationship than the techniques applied by the therapist. Therapists tend to place the greatest emphasis upon techniques and the therapeutic model used, when queried.

I’d like to end with a story taken from my own practice before retirement, after which I turned toward creative writing. (Silent Battlefields: A Novel). I had worked with a Vietnam veteran for over a year. He suffered from what is called Post Traumatic Stress Disorder.

He made considerable gains over that period, including the cessation of drinking alcohol excessively and beginning to experience his feelings once again, whereas he had the sensation of numbness in their stead before entering therapy. I was aware and confident of many techniques that I had brought to bear in my work with him. In our final session, I asked him what he though was most helpful. In response, he explained that after he was discharged he needed to talk about his experiences, but no one wanted to hear about them because they were too “gruesome.” As for his family, they kept slapping him on the back and telling him how proud they were of him, although he had felt anything but pride in what he had done. Then he answered my question: “you listened, you understood, and you cared.”

Article Source: http://www.redsofts.com/articles/

Hugh Rosen is the author of Silent Battlefields. Visit his Web site http://www.hughrosen.com to learn more about his novel of second generation Holocaust survivors.

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